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目的:比较发病6 h内急性前壁心肌梗死应用普通肝素(UFH)或低分子肝素(LWMH)抗凝辅助全量阿替普酶溶栓的临床疗效及安全性。方法:将2009年1月至2012年12月收治的96例急性前壁心肌梗死患者随机分为UFH组与LWMH组各48例,两组在常规治疗基础上分别应用UFH或IWMH联合阿替普酶100mg进行静脉溶栓,比较两组治疗后血管再通率、再灌注时间、心肌抢救指数、临床事件发生率、出血发生率。结果:两组的临床再通率及平均再灌注时间无统计学差异,但两组最终心梗面积、心肌抢救指数、出血发生率和总的主要心血管事件发生率有明显差异(P<0.05),发病第3月时的彩超LVED及LVEF有明显差异(P<0.05)。结论:低分子肝素联合阿替普酶方案可提高急性ST段抬高型前壁心肌梗死的心肌抢救指数,显著降低临床心脏事件发生率和出血发生率,改善心功能。
OBJECTIVE: To compare the clinical efficacy and safety of total demetonation and alteplase thrombolysis with unfractionated heparin (UFH) or low molecular weight heparin (LWMH) anticoagulation in acute anterior myocardial infarction within 6 hours of onset. Methods: A total of 96 patients with acute anterior myocardial infarction admitted from January 2009 to December 2012 were randomly divided into UFH group and LWMH group (n = 48). The two groups were treated with UFH or IWMH combined with atipupine Enzyme 100mg for intravenous thrombolysis. The recanalization rate, reperfusion time, myocardial rescue index, incidence of clinical events and the incidence of bleeding were compared between the two groups after treatment. Results: There was no significant difference in clinical recanalization rate and average reperfusion time between the two groups, but there was a significant difference in the final myocardial infarction size, myocardial rescue index, the incidence of bleeding and the overall incidence of major cardiovascular events between the two groups (P <0.05 ), LVED and LVEF at the third month of onset were significantly different (P <0.05). CONCLUSION: Low molecular weight heparin combined with alteplase can improve the cardiac rescue index of acute ST-segment elevation anterior myocardial infarction, significantly reduce the incidence of clinical cardiac events and bleeding, and improve cardiac function.